Top

Current Hypertension Reports

Published in:

01-01-2018 | Hypertension and Emergency Medicine (T Rainer and P Levy, Section Editors)

Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension

Authors: Andrew King, Mirjana Dimovska, Luke Bisoski

Published in: Current Hypertension Reports | Issue 1/2018

Abstract

Purpose of Review

Acute drug-induced hypertension, sympathomimetic toxicity, and other hyperadrenergic states can be caused by both xenobiotic toxicity and withdrawal. This manuscript is a selective review of the recent literature regarding pharmacologic causes of hypertensive emergencies and other hyperadrenergic states.

Recent Findings

We will discuss designer stimulants, alpha₂ and baclofen agonist withdrawal, and the clinical entity known as posterior reversible encephalopathy syndrome (PRES). Additionally, we examine the controversial “unopposed alpha” phenomenon which may result from use of beta-adrenergic antagonist in the presence of stimulant toxicity.

Summary

These topics encompass clinical situations and disease entities that are increasingly encountered and are often either unanticipated or under-recognized.

•• Hill SL, Thomas SH. Clinical toxicology of newer recreational drugs. Clin Toxicol (Phila). 2011;49(8):705–19. Recent extensive review of available information on synthetic “designer” drugs utilizing peer-reviewed literature to date as well as media and drug user forums, books, and government publications. https://doi.org/10.3109/15563650.2011.615318.CrossRef

Baumann MH, et al. Effects of “Legal X” piperazine analogs on dopamine and serotonin release in rat brain. Ann N Y Acad Sci. 2004;1025(1):189–97. https://doi.org/10.1196/annals.1316.024.CrossRefPubMed

Schep LJ, et al. The clinical toxicology of the designer “party pills” benzylpiperazine and trifluoromethylphenylpiperazine. Clin Toxicol (Phila). 2011;49(3):131–41. https://doi.org/10.3109/15563650.2011.572076.CrossRef

Cho, A.K. and D.S. Segal, Amphetamine and its analogs : psychopharmacology, toxicology, and abuse. 1994, San Diego: Academic Press. xxi, 503 p.

Villalobos CA, et al. 4-Bromo-2,5-dimethoxyphenethylamine (2C-B) and structurally related phenylethylamines are potent 5-HT2A receptor antagonists in Xenopus laevis oocytes. Br J Pharmacol. 2004;141(7):1167–74. https://doi.org/10.1038/sj.bjp.0705722.CrossRefPubMedPubMedCentral

Acuna-Castillo C, et al. Differences in potency and efficacy of a series of phenylisopropylamine/phenylethylamine pairs at 5-HT(2A) and 5-HT(2C) receptors. Br J Pharmacol. 2002;136(4):510–9. https://doi.org/10.1038/sj.bjp.0704747.CrossRefPubMedPubMedCentral

Wood DM, et al. Delayed onset of seizures and toxicity associated with recreational use of Bromo-dragonFLY. J Med Toxicol. 2009;5(4):226–9. https://doi.org/10.1007/BF03178273.CrossRefPubMedPubMedCentral

Meltzer PC, et al. 1-(4-Methylphenyl)-2-pyrrolidin-1-yl-pentan-1-one (Pyrovalerone) analogues: a promising class of monoamine uptake inhibitors. J Med Chem. 2006;49(4):1420–32. https://doi.org/10.1021/jm050797a.CrossRefPubMedPubMedCentral

Bowen JS, et al. Diffuse vascular spasm associated with 4-bromo-2,5-dimethoxyamphetamine ingestion. JAMA. 1983;249(11):1477–9. https://doi.org/10.1001/jama.1983.03330350053028.CrossRefPubMed

10.

Balikova M. Nonfatal and fatal DOB (2,5-dimethoxy-4-bromoamphetamine) overdose. Forensic Sci Int. 2005;153(1):85–91. https://doi.org/10.1016/j.forsciint.2005.04.022.CrossRefPubMed

11.

Andreasen MF, et al. A fatal poisoning involving Bromo-dragonfly. Forensic Sci Int. 2009;183(1–3):91–6. https://doi.org/10.1016/j.forsciint.2008.11.001.CrossRefPubMed

12.

Thorlacius K, Borna C, Personne M. Bromo-dragon fly—life-threatening drug. Can cause tissue necrosis as demonstrated by the first described case. Lakartidningen. 2008;105(16):1199–200.PubMed

13.

Lamberth PG, Ding GK, Nurmi LA. Fatal paramethoxy-amphetamine (PMA) poisoning in the Australian Capital Territory. Med J Aust. 2008;188(7):426.PubMed

14.

Carmo H, et al. CYP2D6 increases toxicity of the designer drug 4-methylthioamphetamine (4-MTA). Toxicology. 2007;229(3):236–44. https://doi.org/10.1016/j.tox.2006.10.024.CrossRefPubMed

15.

Levine M, Levitan R, Skolnik A. Compartment syndrome after “bath salts” use: a case series. Ann Emerg Med. 2013;61(4):480–3. https://doi.org/10.1016/j.annemergmed.2012.11.021.CrossRefPubMed

16.

Elliott S, Smith C. Investigation of the first deaths in the United Kingdom involving the detection and quantitation of the piperazines BZP and 3-TFMPP. J Anal Toxicol. 2008;32(2):172–7. https://doi.org/10.1093/jat/32.2.172.CrossRefPubMed

17.

Gee P, Jerram T, Bowie D. Multiorgan failure from 1-benzylpiperazine ingestion—legal high or lethal high? Clin Toxicol (Phila). 2010;48(3):230–3. https://doi.org/10.3109/15563651003592948.CrossRef

18.

Gee P, et al. Toxic effects of BZP-based herbal party pills in humans: a prospective study in Christchurch, New Zealand. N Z Med J. 2005;118(1227):U1784.PubMed

19.

Austin H, Monasterio E. Acute psychosis following ingestion of “Rapture”. Australas Psychiatry. 2004;12(4):406–8. https://doi.org/10.1080/j.1440-1665.2004.02137.x.PubMed

20.

Thompson I, et al. Randomised double-blind, placebo-controlled trial of the effects of the “party pills” BZP/TFMPP alone and in combination with alcohol. J Psychopharmacol. 2010;24(9):1299–308. https://doi.org/10.1177/0269881109102608.CrossRefPubMed

21.

Wood DM, Dargan PI. Use and acute toxicity associated with the novel psychoactive substances diphenylprolinol (D2PM) and desoxypipradrol (2-DPMP). Clin Toxicol (Phila). 2012;50(8):727–32. https://doi.org/10.3109/15563650.2012.716158.CrossRef

22.

Murray DB, et al. ‘Ivory wave’ toxicity in recreational drug users; integration of clinical and poisons information services to manage legal high poisoning. Clin Toxicol (Phila). 2012;50(2):108–13. https://doi.org/10.3109/15563650.2011.647992.CrossRef

23.

Rosenberg J, et al. Hyperthermia associated with drug intoxication. Crit Care Med. 1986;14(11):964–9. https://doi.org/10.1097/00003246-198611000-00011.CrossRefPubMed

24.

• Rusyniak DE, Sprague JE. Toxin-induced hyperthermic syndromes. Med Clin North Am. 2005;89(6):1277–96. Review of toxin-induced hyperthermia syndromes related to appropriate diagnosis and treatment of these conditions. https://doi.org/10.1016/j.mcna.2005.06.002.CrossRefPubMed

25.

Levy P, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144–52. https://doi.org/10.1016/j.annemergmed.2007.02.022.CrossRefPubMed

26.

Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology. 1996;85(3):655–74. https://doi.org/10.1097/00000542-199609000-00026.CrossRefPubMed

27.

Simic J, et al. Acute myocardial infarction as a complication of clonidine withdrawal. J Emerg Med. 2003;25(4):399–402. https://doi.org/10.1016/j.jemermed.2003.04.002.CrossRefPubMed

28.

Reid JL, Campbell BC, Hamilton CA. Withdrawal reactions following cessation of central alpha-adrenergic receptor agonists. Hypertension. 1984;6(5 Pt 2):II71–5.PubMed

29.

Sarlis NJ, et al. Hyperadrenergic state following acute withdrawal from clonidine used at supratherapeutic doses. Clin Auton Res. 1996;6(2):115–7. https://doi.org/10.1007/BF02291233.CrossRefPubMed

30.

Leckman JF, et al. Rebound phenomena in Tourette’s syndrome after abrupt withdrawal of clonidine. Behavioral, cardiovascular, and neurochemical effects. Arch Gen Psychiatry. 1986;43(12):1168–76. https://doi.org/10.1001/archpsyc.1986.01800120054011.CrossRefPubMed

31.

Berge KH, Lanier WL. Myocardial infarction accompanying acute clonidine withdrawal in a patient without a history of ischemic coronary artery disease. Anesth Analg. 1991;72(2):259–61. https://doi.org/10.1213/00000539-199102000-00023.CrossRefPubMed

32.

Jain P, Misra A. Non-sustained ventricular tachycardia following clonidine withdrawal. Postgrad Med J. 1991;67(786):403–4. https://doi.org/10.1136/pgmj.67.786.403.CrossRefPubMedPubMedCentral

33.

Abrich V, Martin P, Hennick M. Vertebral artery dissection and lateral medullary stroke associated with neck trauma and clonidine withdrawal. N Am J Med Sci. 2013;5(7):443–4. https://doi.org/10.4103/1947-2714.115767.CrossRefPubMedPubMedCentral

34.

Shaw M, Matsa R. Clonidine withdrawal induced sympathetic surge. BMJ Case Rep. 2015;2015

35.

Fitzgibbon D, et al. Rebound hypertension and withdrawal associated with discontinuation of an infusion of epidural clonidine. Anesthesiology. 1996;84(3):729–31. https://doi.org/10.1097/00000542-199603000-00031.CrossRefPubMed

36.

Lee HM, Ruggoo V, Graudins A. Intrathecal clonidine pump failure causing acute withdrawal syndrome with ‘Stress-Induced’ cardiomyopathy. J Med Toxicol. 2016;12(1):134–8. https://doi.org/10.1007/s13181-015-0505-9.CrossRefPubMed

37.

Gupta P, et al. Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease. Pediatr Crit Care Med. 2012;13(6):660–6. https://doi.org/10.1097/PCC.0b013e318253c7f1.CrossRefPubMed

38.

• Shehabi Y, et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med. 2004;30(12):2188–96. Helpful review of alpha ₂ agonist withdrawal in the form of an editorial, discussing the possibility of tolerance and withdrawal from an ICU physician perspective. https://doi.org/10.1007/s00134-004-2417-z.CrossRefPubMed

39.

Kukoyi A, et al. Two cases of acute dexmedetomidine withdrawal syndrome following prolonged infusion in the intensive care unit: report of cases and review of the literature. Hum Exp Toxicol. 2013;32(1):107–10. https://doi.org/10.1177/0960327112454896.CrossRefPubMed

40.

Weber MD, Thammasitboon S, Rosen DA. Acute discontinuation syndrome from dexmedetomidine after protracted use in a pediatric patient. Paediatr Anaesth. 2008;18(1):87–8. https://doi.org/10.1111/j.1460-9592.2007.02377.x.CrossRefPubMed

41.

Houston MC. Treatment of hypertensive emergencies and urgencies with oral clonidine loading and titration. A review. Arch Intern Med. 1986;146(3):586–9. https://doi.org/10.1001/archinte.1986.00360150236029.CrossRefPubMed

42.

Gagnon DJ, et al. Transition from dexmedetomidine to enteral clonidine for ICU sedation: an observational pilot study. Pharmacotherapy. 2015;35(3):251–9. https://doi.org/10.1002/phar.1559.CrossRefPubMed

43.

Lardieri AB, et al. Effects of clonidine on withdrawal from long-term dexmedetomidine in the pediatric patient. J Pediatr Pharmacol Ther. 2015;20(1):45–53. https://doi.org/10.5863/1551-6776-20.1.45.PubMedPubMedCentral

44.

Tobias JD. Dexmedetomidine: are tolerance and withdrawal going to be an issue with long-term infusions? Pediatr Crit Care Med. 2010;11(1):158–60. https://doi.org/10.1097/PCC.0b013e3181ae49af.CrossRefPubMed

45.

Bowcock E, Morris I, Lane A. Dexmedetomidine for acute clonidine withdrawal following intrathecal pump removal: a drug beginning to find its expanding niche. J Intensive Care Soc. 2016;17(3):271–2. https://doi.org/10.1177/1751143716638374.CrossRefPubMedPubMedCentral

46.

Awuor SO, et al. Intrathecal baclofen withdrawal: a rare cause of reversible cardiomyopathy. Acute Card Care. 2016;18(1):13–7. https://doi.org/10.3109/17482941.2016.1174273.CrossRefPubMed

47.

Cardoso AL, Quintaneiro C, Seabra H, Teixeira C. Cardiac arrest due to baclofen withdrawal syndrome. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2014-204322.

48.

D’Aleo G, et al. Hallucinations after abrupt withdrawal of oral and intrathecal baclofen. Funct Neurol. 2007;22(2):81–8.PubMed

49.

Stetkarova I, et al. Intrathecal baclofen in spinal spasticity: frequency and severity of withdrawal syndrome. Pain Physician. 2015;18(4):E633–41.PubMed

50.

•• Watve SV, et al. Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord. 2012;50(2):107–11. Recent review of studies relevant to the management of patients with intrathecal baclofen overdose and withdrawal. https://doi.org/10.1038/sc.2011.112.CrossRefPubMed

51.

Specchio N, et al. Prolonged episode of dystonia and dyskinesia resembling status epilepticus following acute intrathecal baclofen withdrawal. Epilepsy Behav. 2011;21(3):321–3. https://doi.org/10.1016/j.yebeh.2011.04.052.CrossRefPubMed

52.

Kao LW, et al. Intrathecal baclofen withdrawal mimicking sepsis. J Emerg Med. 2003;24(4):423–7. https://doi.org/10.1016/S0736-4679(03)00039-8.CrossRefPubMed

53.

Morr S, et al. Dexmedetomidine for acute baclofen withdrawal. Neurocrit Care. 2015;22(2):288–92. https://doi.org/10.1007/s12028-014-0083-8.CrossRefPubMed

54.

Greenberg MI, Hendrickson RG. Baclofen withdrawal following removal of an intrathecal baclofen pump despite oral baclofen replacement. J Toxicol Clin Toxicol. 2003;41(1):83–5. https://doi.org/10.1081/CLT-120018277.CrossRefPubMed

55.

• Finkel JB, Marhefka GD. Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc. 2011;86(12):1198–207. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.4065/mcp.2011.0338.CrossRefPubMedPubMedCentral

56.

• Freeman K, Feldman JA. Cocaine, myocardial infarction, and beta-blockers: time to rethink the equation? Ann Emerg Med. 2008;51(2):130–4. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1016/j.annemergmed.2007.08.020.CrossRefPubMed

57.

• Leikin JB. Cocaine and beta-adrenergic blockers: a remarriage after a decade-long divorce? Crit Care Med. 1999;27(4):688–9. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1097/00003246-199904000-00012.CrossRefPubMed

58.

• Mariani PJ. Beta-blockers following cocaine use: a reappraisal. Ann Emerg Med. 2008;52(1):89; author reply 89–90. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1016/j.annemergmed.2007.11.048.

59.

• Page RL II, Utz KJ, Wolfel EE. Should beta-blockers be used in the treatment of cocaine-associated acute coronary syndrome? Ann Pharmacother. 2007;41(12):2008–13. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1345/aph.1H643.CrossRefPubMed

60.

• Richards JR, et al. Beta-blockers, cocaine, and the unopposed alpha-stimulation phenomenon. J Cardiovasc Pharmacol Ther. 2017;22(3):239–49. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1177/1074248416681644.CrossRefPubMed

61.

• Schurr JW, Gitman B, Belchikov Y. Controversial therapeutics: the beta-adrenergic antagonist and cocaine-associated cardiovascular complications dilemma. Pharmacotherapy. 2014;34(12):1269–81. Review of cocaine-associated chest pain and beta-blocker use from a unique author’s perspective. https://doi.org/10.1002/phar.1486.CrossRefPubMed

62.

•• Richards JR, et al. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila). 2016;54(5):345–64. Most extensive and recent review on available evidence regarding the treatment of cocaine-related cardiovascular toxicity to date. https://doi.org/10.3109/15563650.2016.1142090.CrossRef

63.

Hysek CM, Vollenweider FX, Liechti ME. Effects of a beta-blocker on the cardiovascular response to MDMA (Ecstasy). Emerg Med J. 2010;27(8):586–9. https://doi.org/10.1136/emj.2009.079905.CrossRefPubMed

64.

Burkhart KK. Intravenous propranolol reverses hypertension after sympathomimetic overdose: two case reports. J Toxicol Clin Toxicol. 1992;30(1):109–14. https://doi.org/10.3109/15563659208994450.CrossRefPubMed

65.

Rappolt RT Sr, et al. Treatment plan for acute and chronic adrenergic poisoning crisis utilizing sympatholytic effects of the B1-B2 receptor site blocker propranolol (Inderal) in concert with diazepam and urine acidification. Clin Toxicol. 1979;14(1):55–69. https://doi.org/10.3109/15563657909030114.CrossRefPubMed

66.

Akay S, Ozdemir M. Acute coronary syndrome presenting after pseudoephedrine use and regression with beta-blocker therapy. Can J Cardiol. 2008;24(11):e86–8. https://doi.org/10.1016/S0828-282X(08)70200-9.CrossRefPubMedPubMedCentral

67.

• Dattilo PB, Hailpern SM, Fearon K, Sohal D, Nordin C. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use. Ann Emerg Med. 2008;51(2):117–25. Retrospective cohort study demonstrating an association of reduced risk for MI in patients with positive drug screens for cocaine who received beta blockade during admission. https://doi.org/10.1016/j.annemergmed.2007.04.015.CrossRefPubMed

68.

Hoskins MH, et al. Effects of labetalol on hemodynamic parameters and soluble biomarkers of inflammation in acute coronary syndrome in patients with active cocaine use. J Cardiovasc Pharmacol Ther. 2010;15(1):47–52. https://doi.org/10.1177/1074248409358409.CrossRefPubMed

69.

• Ibrahim M, Maselli DJ, Hasan R, Hamilton A. Safety of beta-blockers in the acute management of cocaine-associated chest pain. Am J Emerg Med. 2013;31(3):613–6. Retrospective chart review of patients with cocaine-associated chest pain showing no increase in troponin in patients who received beta blockers during admission compared to those who did not. https://doi.org/10.1016/j.ajem.2012.09.027.CrossRefPubMed

70.

• Rangel C, et al. Beta-blockers for chest pain associated with recent cocaine use. Arch Intern Med. 2010;(10):170, 874–9. Retrospective review of patients with positive urine drug screen for coccaine comparing those who received a beta-blocker with those who did not, showing no association with adverse event.

71.

•• Honderick T, Williams D, Seaberg D, Wears R. A prospective, randomized, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes. Am J Emerg Med. 2003;21(1):39–42. Basis of the evidence for benzodiazepine use in cocaine-associated chest pain. Randomized controlled trial showing improvement in pain in patients who received lorazepam + nitroglycerine vs nitroglycerin alone. https://doi.org/10.1053/ajem.2003.50010.CrossRefPubMed

72.

• Baumann BM, Perrone J, Hornig SE, Shofer FS, Hollander JE. Randomized, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes. Acad Emerg Med. 2000;7(8):878–85. Randomized controlled trial showing no difference in diazepam + nitroglycerin versus nitroglycerin alone in the resolution chest pain or changes in stroke index. https://doi.org/10.1111/j.1553-2712.2000.tb02065.x.CrossRefPubMed

73.

Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494–500. https://doi.org/10.1056/NEJM199602223340803.CrossRefPubMed

74.

Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc. 2010;85(5):427–32. https://doi.org/10.4065/mcp.2009.0590.CrossRefPubMedPubMedCentral

75.

•• Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914–25. Most recent and comprehensive review regarding etiology, diagnosis, and treatment of PRES to date. https://doi.org/10.1016/S1474-4422(15)00111-8.CrossRefPubMed

76.

Granata G, et al. Posterior reversible encephalopathy syndrome—insight into pathogenesis, clinical variants and treatment approaches. Autoimmun Rev. 2015;14(9):830–6. https://doi.org/10.1016/j.autrev.2015.05.006.CrossRefPubMed

77.

Zekic T, et al. The multifactorial origin of posterior reversible encephalopathy syndrome in cyclophosphamide-treated lupus patients. Rheumatol Int. 2017;37(12):2105–14. https://doi.org/10.1007/s00296-017-3843-x.CrossRefPubMed

78.

Gharabawy R, et al. Epinephrine-induced posterior reversible encephalopathy syndrome: a case report. J Clin Anesth. 2011;23(6):505–7. https://doi.org/10.1016/j.jclinane.2010.12.017.CrossRefPubMed

79.

Jayaweera JL, et al. Cyclophosphamide-induced posterior reversible encephalopathy syndrome (PRES): a case report. J Med Case Rep. 2014;8(1):442. https://doi.org/10.1186/1752-1947-8-442.CrossRefPubMedPubMedCentral

80.

Omer TA, Doherty C. Posterior reversible encephalopathy syndrome (PRES) complicating the ‘legal high’ mephedrone. BMJ Case Rep. 2011;2011

81.

• Song T, Rao Z, Tan Q, Qiu Y, Liu J, Huang Z, et al. Calcineurin inhibitors associated posterior reversible encephalopathy syndrome in solid organ transplantation: report of 2 cases and literature review. Medicine (Baltimore). 2016;95(14):e3173. Good recent review and report of current understanding regarding the connection between PRES and 2 of its most commonly associated agents. https://doi.org/10.1097/MD.0000000000003173.CrossRef

82.

Wang W, Zhao LR, Lin XQ, Feng F. Reversible posterior leukoencephalopathy syndrome induced by bevacizumab plus chemotherapy in colorectal cancer. World J Gastroenterol. 2014;20(21):6691–7. https://doi.org/10.3748/wjg.v20.i21.6691.CrossRefPubMedPubMedCentral

Title: Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension
Authors: Andrew King
Mirjana Dimovska
Luke Bisoski
Publication date: 01-01-2018
Publisher: Springer US
Published in: Current Hypertension Reports / Issue 1/2018
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI: https://doi.org/10.1007/s11906-018-0807-9

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 1/2018

Implementing ABPM into Clinical Practice

The Interactions of the Immune System and the Brain in Hypertension

Therapeutic Inertia and Treatment Intensification

Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature

Possible Breathing Influences on the Control of Arterial Pressure After Sino-aortic Denervation in Rats

Role of Thioredoxin in Age-Related Hypertension

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage